Inflammatory Pathology of the Human Breast

Introduction

Inflammation breast cancer (IBC) refers to a rare and highly aggressive disease where lymph vessels are blocked by cancer cells in the breast skin. This form of cancer is regarded as inflammatory since the breast frequently seems inflamed, red or swollen. IBC is rare form of breast cancer which accounts for 1 to 5% of all diagnosed breast cancers in the United States. Majority of IBC are invasive ductal carcinoma which implies that they developed from breast milk ducts and then spread past the ducts. IBC progress drastically, mostly within weeks or months, and thus most patients are normally at stage III or IV during diagnosis.  This paper analyses the IBC pathology.

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Epidemiology

IBC is said to be more common to Black women than white women, such that blacks are said to have 50% higher incidences compared to whites. IBC is said to be record at younger age in both groups compared to non-inflammatory breast cancers. Inflammation breast cancer patients are said to have a shorter survival rate compared non-IBC breast cancer patients. Hispanic women are said to have the youngest IBC onset age of around 50.5 years, contrasted to black women with onset age of 55.2 and white women onset age of 58.1. The cases of IBC are also increasing with time compared to cases of non-inflammatory breast cancer. IBC also has a tumor with more estrogen receptor (ER)-negative and higher tumor grade compared to non-inflammatory breast cancer where ER- and ER+ tumors incidences are equal. IBC is said to account for 2.5% of all breast cancer cases incident. IBC is also highly common among women with obesity.

Etiology

IBC is said to be caused by infectious virus which include mouse mammary tumor-like viruses (MMTV), and human papillomavirus (HPV). A provirus structure containing 96% homology containing MMTV referred to as HCMV, Epstein-Barr virus (EBV), and human mammary tumor virus (HMTV) were also related with development of IBC tumor.  Other organisms detected in IBC tumors include Bartonella henselae; a gram-negative bacteria, and Brucella sp, also a gram-ve bacteria which is said to cause medulloblastomas. IBC is also associated with environmental factors, climatic factors and poor social economic factors that encourage the spread of infections.

Inflammation breast Cancer Types/Classification

Inflammatory breast cancer can be classified into three main stages. These stages include stage IIIB, stage IIIC, and stage IV. IBC is said to be in stage IIIB when the cancer has spread to tissues surrounding the breast for instance chest wall, ribs, muscles, skin or lymph nodes at the armpit. IBC is said to be in IIIC stage when it has reached the lymph nodes below collarbone and close to the neck and also to other areas identified in IIIB. IBC is said to be in stage IV if it has reached other organs such as brain, liver, lungs, or bones and also neck lymph nodes.   

Inflammation Breast Cancer Signs/Symptoms

IBC signs and symptoms include breast pain, itching of the breast, self-diagnosed and rapidly growing breast lump. The may as well report enlarged, firm or tender breast. The skin covering the breast thicken and becomes warm and its color also changes from initial discoloration of pink flush to purplish or redness kind that appears to represent ecchymosis. Nipple may appear retract, flattening, blistering, erythema, or crusting Most women with IBC experience lymph node and about 33% do report distant metastases. Thus some patients might report localizing pain or swollen lymph nodes. Symptoms may vary among patients based on extent and location of metastatic disease. In most cases patient are given antibiotics to treat assumed mastitis with no improvement initiating further assessment.

Pathologic Features/ Genetic Basis of Disease

There are no unique known genetic risks for IBC. However, genetic factors which increase risks of an individual for developing other forms of cancer that include breast cancer gene one, (BRCA1) or breast cancer gene two (BRCA 2), might also increase breast cancer inflammatory. Breast cancer mutations susceptibility genes which include BRCA2 and BRCA1 are responsible for the most of hereditary incidences of breast cancer.

Laboratory Features

IBC symptoms that include nipple discharge or skin change can be evaluated in the triple test. This involves breast examination by the doctor, breast imaging via ultrasound or mammography, and breast tissues sampling with open biopsy, core biopsy or fine needle aspiration (FNA). Blood tests which include liver function tests and full blood count test may be done to determine whether the cancer has reached the bone marrow or liver.

Differential Diagnosis

The differential diagnosis for breast inflammation includes benign disease as well as other malignancies. Lactation mastitis happens to about 10% of lactating women and is related to leukocytosis, fever, and localized tenderness which is features which assist in differentiating it from IBC. The erythema is related with tenderness and inhabits a wedge-shaped breast quadrant, and the patient seems unwell. Nonlactating breast benign entity is duct ectasia which influences postmenopausal and perimenopausal women. It happens after fatty material clog duct beneath the nipples creating a lump. Other IBC benign entities include fat necrosis and mondor disease. Malignant entities which imitator IBC is leukemic breast infiltration.

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Inflammation Breast Cancer Management/Treatment

IBC patients need coordination of radiation, surgical and medical oncology care and nursing. IBC management entails modality combined therapy. Preoperative chemotherapy is thus standard care. Chemotherapy is regarded as optimal measure since it treat both main cancer tumor and any other cancer cells which might have broken and spread to other body parts. Surgery may follow the chemo therapy after the patients’ condition has improved. Hormonal therapy should also be done and target therapy. Radiation therapy can also be used to enhance IBC treatment.

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Complications

IBC is a complicated condition to treat especially because it is highly aggressive and spread out much quickly. It is therefore considerably hard to manage it using surgical procedures. Moreover, reconstructive surgery may not be appropriate due to the spread out even after a successful surgery. Moreover, there are common chemotherapy side effects which include febrile neutropenia risk, vomiting and nausea, and alopecia. Other possible complications include severe fever, myalgias or bony pain.   

Prognosis

Women suffering from IBC present serious prognoses compared to women suffering from other breast cancer. In addition about 25% of women have incurable, metastatic disease. The IBC patients’ general survival rate ranges between 29 and 4.2 years, and has not demonstrated any significant change for the last 30 years. Novel biological agents that include lapatinib and trastuzumab may enhance IBC patients’ results.

Current/Future There have been a number of researches in the past focusing on establishing ways to enhance diagnosis of IBC at its early stages to eliminate the mastitis pre-assumption that gives the condition a chance to spread further before right diagnosis is done. However, more research is required to enhance establishment of molecular principles differentiating IBC from non-inflammatory breast cancer. These criteria would be useful for development and diagnosis of new targeted therapy. Inflammation breast cancer patients’ survival rate has been below 5 years for over three decades despite of improved IBC treatment techniques in the recent past. Thus more research is needed to determine the cause of this and what can be done to improve the situation.

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